ICD-10 Workflow
ICD-10 Overview
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) published by the World Health Organization (WHO). ICD codes are used to classify diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
On October 1, 2015 (the effective date), the ICD-9 code sets used to report medical diagnoses and procedures are replaced by ICD-10 code sets that are more specific. All the codes are now stored in the Allscripts Terminology Platform (ATP) database that is installed with the Netsmart Homecare application.
ICD-10 Setup
To use the ICD-10 functionality, perform the following setup:
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In Administration > Configuration > Operators > Privileges [Scope Name] > Patient > General > Diagnoses, grant the privileges for using the Diagnoses window as appropriate: |
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In Administration > Configuration > Operators > Privileges [Scope Name] > Reports > Clinical, grant the privilege for the Patients with Unresolved Diagnoses report. |
ICD-9 Unresolved Diagnoses Warnings for Business Unit
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Upload all Field Mode data to Host Mode before upgrading to 9.0 to avoid cache issues. See Diagnoses and Procedures in Field Mode. |
License for Enhanced Diagnoses Search
By default, an agency will have two licenses for the enhanced diagnoses search to facilitate converting diagnoses and procedures from ICD-9 to ICD-10 codes. With the license, you can search diagnoses and procedures not only by the code or name, but also by provider-friendly names, and view mapped ICD-9 and ICD-10 diagnoses or procedures.
Note: If you search for diagnoses or procedures by provider-friendly terms, the name of the diagnosis/procedure that is prefilled in the Description field of the Diagnoses window may be different from the provider-friendly term that you selected in search results.
You can assign these licenses to the selected operators in Administration > Configuration > Operators > Privileges > Enhanced Diagnoses Search.
If you have two licenses in the organization, then two operators can simultaneously use the enhanced search. If needed, you can reassign licenses from one operator to another (for example, if an operator is on vacation).
Note: To obtain more licenses, contact Netsmart Homecare Support Services.
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If necessary, set up profiles that are default care plans for particular patient diagnoses and procedures (Administration > Clinical > Profiles). |
Diagnoses and Procedures in Field Mode
In Field Mode, you can do the following:
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Access ICD-10 codes only after the ICD-10 organization effective date. |
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Add free-text diagnoses and procedures. |
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Select free-text diagnoses as the primary diagnoses for a patient with the closed diagnoses group. See Free-Text Diagnoses as the Primary Diagnoses. |
Free-Text Diagnoses as the Primary Diagnoses
If a patient with the diagnoses group was discharged and the group was closed, you can readmit this patient in Field Mode in the Admissions & Status window even though the diagnoses group is closed by adding the free-text diagnosis. To readmit the patient, do the following:
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In Field Mode, go to Patient > General > Admissions & Status, specify the needed details to readmit the patient, and select the free-text diagnosis in the Diagnosis field. |
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In Host Mode, create new diagnoses group and save the changes. |
Synchronization Before Upgrade
You must synchronize with Host Mode before upgrading to 9.0 to avoid cache issues. If you do not synchronize all the Field Mode data before the upgrade, modified patient's diagnoses will be converted to a free text and you will have to manually convert all the diagnoses and procedures. For the diagnoses specified in the M1024 field, the description will include the name of this field. For example, "M1024.3 = 032.2, ICD9 = V80.1, Screening for glaucoma" means that for the V80.1 diagnosis, there was a diagnosis with the 032.2 code in the M1024 field, in the 3 column.
ICD-9 to ICD-10 Conversion
After the ICD-10 organization effective date, ICD-10 diagnoses and procedures are required in the application. For each ICD-9 code, at least one ICD-10 code must be added.
To convert ICD-9 codes in time, do the following:
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Make sure that you see the notifications about unresolved diagnoses before the ICD-10 organization effective date (see ICD-10 Setup). |
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Identify patients for whom ICD-10 codes are not defined. Run the Patients with Unresolved Diagnoses report. |
Free Text into ICD Code Conversion
Free-text medical diagnoses and procedures are used for specifying patient's condition in Field Mode. They do not generate orders or claims, and therefore must be replaced with the ICD codes. You can use manual or automatic process for converting free-text records into the appropriate ICD codes.
If your agency has a dedicated coder, then the process for working with free-text diagnoses and procedures can be the following.
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In Field Mode, a clinician adds free-text diagnosis or procedure (with the Free Text type). |
Tip: You can establish process of including diagnoses sequence in the free-text descriptions so that the Host Mode user (coder) can set sequences when converting diagnoses. For example, type "Fear of crowd, sequence 4" in the Description field.
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In Host Mode, a coder runs the Patients with Unresolved Diagnoses report. |
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The coder clicks a patient name with the Free-text diagnoses/procedures are not converted reason. |
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The Diagnoses window opens. Coder converts free text into the appropriate ICD code. |
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If the free-text diagnosis was used in the assessment, then the user should refresh the assessment by going to the Diagnoses Entry M1020-M1024 page, and clicking the Go to Diagnoses button. |
If your agency does not have a dedicated coder, then you can use automatic conversion of free-text diagnoses and procedures.
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In Field Mode, a clinician adds codes for free-text diagnoses or procedures. |
Important: The valid ICD code (not the description) must be entered in the Description field and the corresponding ICD code type (ICD-9 or ICD-10) must be selected in the drop-down list.
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The Host Mode user runs the Patients with Unresolved Diagnoses report to check the codes that were not converted automatically. If there are patients with the Diagnosis/Procedure code entered in Field Mode is not auto-resolved reason, then this means that not all criteria for automatic conversion were met. The Host Mode user clicks a patient name. |
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The Diagnoses window opens. The Host Mode user manually converts the code that was not auto-resolved into the appropriate ICD code. |
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If the free-text diagnosis was used in the assessment, the user should refresh the assessment by going to the Diagnoses Entry M1020-M1024 page, and clicking the Go to Diagnoses button. |
Diagnoses Groups Considerations (ICD-9 and ICD-10)
Consider setting up diagnoses groups for a patient because they are helpful in the following situations:
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Patient's primary diagnosis is ICD-10, but the payer is not ready to accept ICD-10 codes. In this case, the system can identify primary diagnosis from the ICD-9 group and report the appropriate code on a claim. See ICD-10 on Claims. |
Important: If you have ICD-9 and ICD-10 diagnoses groups (even though ICD-10 diagnoses are not required yet), primary diagnosis should be identified for each group on its start date.
If you use diagnoses groups and manual conversion of free-text diagnoses, then in Field Mode, when adding a new diagnosis, consider including the sequence in the free-text description to help a coder easily set the sequence in a group during conversion process. For example, type "Fear of crowd, sequence 4" in the Description field.
ICD-10 on Orders
ICD-10 codes are reported on orders after the ICD-10 organization effective date (see ICD-10 Setup). Orders are not created if a patient has free-text diagnoses or procedures on the start date of the certification period.
ICD-10 on Reports
Reports show ICD-10 diagnoses and procedures including free text based on the ICD-10 organization effective date. If the effective date is within the reporting period, then both ICD-9 and ICD-10 codes are shown. For grouping of diagnoses groups, only the first level is considered. For more information, refer to the description of the needed report.
ICD-10 on Claims
ICD-10 codes are reported on claims after the ICD-10 effective date that can be set up in the following places:
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Organization Level – The date is used for claims if the specific date for a payer is not defined. |
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Insurance Level – The date can be specified for the insurance plan, company, or insurance code if a payer is not ready to process claims with ICD-10 codes (see ICD-10 Setup). |
If a payer is not ready to accept ICD-10 codes after the organization effective date (example 1), set up the payer effective date and add diagnoses groups for both ICD-9 and ICD-10 codes. In this case, the system will report the ICD-9 diagnosis with the sequence 1 that must correspond to the ICD-10 diagnosis with the sequence 1.
*If you do not set up groups and do not add the status line with the ICD-10 diagnosis, then the ICD-9 code is reported. This is considered as incorrect setup because after the ICD-10 organization effective date, you should add ICD-10 code for primary diagnosis. The Claim Alerts report will show the alerts with the reason E in such cases.
For details, see Diagnoses Groups Considerations (ICD-9 and ICD-10). If you do not use diagnoses groups, make sure that the status line is added with the ICD-10 diagnosis.
For more information on how to set up diagnoses groups, see Creating Diagnoses Group for a Patient (Host Mode).
Final claims with an episode start date prior to the ICD-10 effective date and ending after this date show the ICD-10 primary and other diagnoses that are active as of the claim thru date (and not ICD-9 codes that were reported for the Initial claim). For the rest of episodes, the application reports diagnoses active as of the claim from date.
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Final claim dates: September 28, 2015 – November 26, 2015 (this is where the claim is overlapping the ICD-10 effective date (October 1, 2015)) |
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You can use the Claim Alerts report (see Claim Alerts Report in the Financial User's Guide) to identify which claims were not generated due to free-text diagnoses and convert them appropriately.
Also, the report will show alerts for claims when the primary diagnosis code is incorrect due to effective date or free-text primary diagnosis regardless of any billing rules. For details, see the reason E in the Episodic Claims and Pending Non-Episodic Claims subreports.
Admitting Diagnosis Code on UB-04
If the admission diagnosis code is ICD-9, but you need to print the corresponding ICD-10 code on a claim (or inversely), then use a claim constant in Patient > General > Claim Constants for Form Locator 69 - Admitting Diagnosis Code and enter the needed diagnosis code in the Value field.
ICD-10 Workflow References
The workflow contains the condensed information on ICD-9/ICD-10 functionality in Netsmart Homecare. To get the full information (overviews, privileges descriptions in detail, procedures related to specific tasks), please review the following topics:
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Privileges: Patient – General and Reports – Clinical |
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Operators Window – Privileges Tab – Enhanced Diagnoses Search Subtab |
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Diagnosis Groups WindowDiagnosis Groups Window in the Allscripts Homecare Administration User's Guide |
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